Individual
JENNIFER TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CDC-1, ICCTP
Contact information
Practice address
10735 KENAI SPUR HWY # 2B, KENAI, AK 99611-7859
(907) 283-9947
(907) 283-9949
Mailing address
1700 LAWTON DR # A, KENAI, AK 99611-8913
(907) 283-9947
(907) 283-9949
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1025263
AK
174400000X
Specialist
1023805
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023805
STATE OF AK
AK
01
—
1025263
STATE OF AK
AK
Enumeration date
08/30/2015
Last updated
08/30/2015
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